My father, 87, has been diagnosed with a 90% blockage of the right carotid artery. His doctor will not do surgery, even though Dad experiences dizzy spells. The left artery seems to be OK. He has been placed on medication to reduce cholesterol, stopped smoking in the late 40s, is very definitely not overweight. The previous cholesterol medication made him very weak. Should we investigate a stent for this problem? Or is surgery not indicated at all?

The most important thing is to be absolutely certain that the dizziness and the 90% stenosis in the right carotid are related. It is unusual to have dizziness due to carotid stenosis unless that carotid somehow provides flow to posterior circulation due to blockage in the vertebral of the subclavian arteries. This can be done by evaluating the carotid Doppler and maybe even perfoming a transcranial doppler to evaluate the posterior circulation. If the two are related, than given that your dad is symptomatic from that blockage and has high surgical risk features, the percutaneous approach with stenting would be indicated.

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